Helping Clients Use Out-of-Network Benefits: What Options You and Your Clients Have

For many therapists in private practice, it can be tempting to join the club when it comes to insurance networks. Still, there are a few reasons why being an out-of-network therapist is more beneficial than being an in-network therapist — for both you and your clients.

Being an out-of-network therapist means that you don’t have to jump through the hoops of insurance companies, hoops that often change each year and can be rigorous in their requirements. You’ll also save time because you won’t need to complete the necessary in-network paperwork (think diagnosis, detailed notes, and payment details). Perhaps most importantly, being an out-of-network therapist means that your services get their full value, as you have the ability to set your own rates and won’t be beholden to the insurance company’s valuation.

For clients, seeing an out-of-network therapist can be a better option than using their insurance companies’ in-network provider list. They’ll have a greater selection of therapists, which means that they can choose a therapist who not only offers the exact services they’re looking for (like EMDR) but also one whose style and personality clicks with their own.

So what options do you and your clients have when it comes to out-of-network billing? On Zencare, we indicate the out-of-network options for each therapist in our directory to make it easy for clients to check out the possibilities. We’ve listed out a few key pieces of information to get you started when deciding what to offer.

Super billing

Super billing is a billing option in which the therapist provides the client with a claim, and then the client submits that claim to their insurance company. This means that the client pays each session fee upfront and from their own pocket. They’ll complete the necessary paperwork (proof of the session, proof of payment, details about your treatment, request for reimbursement) to the insurance company and receive reimbursement down the line. The super bill will generally include all of the pertinent information, such as diagnosis codes, CPT codes, and more.

There are many reasons why super billing is a helpful billing option for clients and therapists alike. Here are a few pros for using super billing:

However, there are also limitations to super billing as a billing option, including:

There are many excellent resources available to practice owners to make the super billing process easier; Simple Practice is one example of a practice management tool that makes creating super bill templates straightforward.

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Direct billing

The second billing option for out-of-network therapists is direct billing. Direct billing is when a therapist submits a claim to the insurance company directly and receives the reimbursement. Using this billing option, the client does not have to pay the full session cost out of their own pocket and does not have to complete any regular paperwork.

This billing option is useful for therapists because:

The drawbacks to direct billing, though, include the following:

Courtesy billing

The final out-of-network billing option is courtesy billing, which combines elements of direct and super billing. The therapist submits the insurance reimbursement claim, but instead of the therapist getting reimbursed for the service, the client will get reimbursed for the session fee less their coinsurance. The client is responsible for paying for the session fee upfront and the therapist takes care of the necessary paperwork with the insurance company so that the client gets some money back.

There are many pros to this billing option, such as:

Some challenges that arise with courtesy billing, however, include:

No matter which billing option you choose as an out-of-network therapist, there are ways to help your clients navigate their insurance benefits. These are great ways to support your clients in more ways than during your sessions — though these billing options are also beneficial to you and your practice.

Whichever billing options you chose, you can indicate what’s available for your clients on your Zencare profile. We want to ensure best-of-fit between client and therapist, and that means being on the same page about billing and payments.

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